On Wednesday, 28 April, Premier Alan Winde launched the Western Cape Government’s multi-sectoral emergency response plan to reduce the spread of Tuberculosis (TB) in the Western Cape. This followed my commitment on World TB Day (24 March) to report back on our fully-fledged action plan within one month.
He was joined for the launch by the Minister of Health, Dr Nomafrench Mbombo and the Head of Health, Dr Keith Cloete, Councillor Ronel Viljoen and Vuyani Macotha as well as the civil society partners who form part of the Premier’s Council on Aids and TB (PCAT).
We have formulated this response plan in recognition of the major impact which TB has on lives and livelihoods in our province. It takes an evidence-based and data-driven approach to slowing TB, ensuring that we apply the same energy to fighting TB from this point on, as we did to fighting Covid-19 over the last year.
The multi-sectoral TB emergency response plan was approved by the PCAT on Monday afternoon, ahead of today’s launch. Speaking to the response plan, the Co-Chair of PCAT, Vuyani Macotha said: “I’m excited by the gaps we’ve identified. This is not just a document sitting in Premier’s office but a tool to be shared with NGOs and government. We have used the same approach to address Covid.”
Member of PCAT, Mokgadi Malahlela, remarked that “I’m very happy and proud of what is coming about in the Western Cape. We were the first province to declare TB an emergency. National Government has since been lobbied to follow suit.”
The impact of TB on our healthcare system and economy
The fight against TB is now more urgent than ever. Globally, it is estimated that the Covid-19 pandemic has set back the fight against TB by between 5 and 8 years and could result in an additional 6.3 million cases of TB between 2020 and 2025.
The reality is that the Covid-19 pandemic curbed global efforts to respond to TB, and we must now step up the fight drastically.
In South Africa, the National Institute of Communicable Diseases (NICD) highlighted that there was a 30% decrease in TB diagnosis in the first five months of the Covid-19 pandemic. This is on top of an estimation that 42% of people with TB were already not being diagnosed and treated.
In the Western Cape, the spread of TB in our province has for decades negatively impacted the wellbeing of our residents, the healthcare system and our economy.
These consequences were amplified by the Covid-19 pandemic, especially during the highest lockdown levels. If we compare the period of April 2019 – December 2019 to April 2020 – December 2020, we note that there was a:
- 35% drop in the number of clients who came to facilities in April 2020 compared to April 2019. There was an increase in TB screenings from October 2020;
- 54% decline in April 2020 compared to April 2019 in the number of individuals tested for TB. Overall, there was a decline in individuals tested from April 2020 to December 2020, compared to the year before; and
- 53% decline in April 2020 compared to April 2019 in the number of people diagnosed with TB in the Western Cape. Overall, there was a decline in TB cases diagnosed from April 2020 and December 2020, compared to the year before.
The provincial client death rate for TB is 3.8%, with 1685 deaths out of 44077 cases diagnosed in 2019/20.
We care about addressing TB because it is a disease that impacts the most vulnerable in our society. The risk of TB is highest amongst people living in poverty, who have poor immunity (including people who are HIV-positive), and who are either very young or old. The risk of TB transmission also increases with the closeness and duration of contact to those already infected with active TB and the degree of infectiousness of the TB patient.
The Western Cape Provincial Council of AIDS and TB, which I co-chair, has deemed this a crisis requiring an emergency response.
The Western Cape Department of Health cannot address these social ills alone. That is why the response plan is an integrated and multi-sectoral effort to address TB. Addressing the social causes of health is a shared responsibility across programmes and stakeholders within and beyond the health sector. Much the same as with Covid-19, we all need to play a role.
Lesson learnt from the Covid-19 pandemic
In responding to the Covid-19 pandemic, the province has proven its ability to formulate agile, innovative and effective responses to health challenges. We have done this by adopting a whole-of-society and whole-of-government approach. Our Covid-19 response has also shown us the power of combining a health systems response, with behaviour change and whole-of-society support. We have now taken the lessons we learnt from our fight against Covid-19 and adapted them for our TB response plan.
We believe that through this plan, we can prevent TB infection, link TB positive patients to treatment more quickly and ultimately save lives, as well as grow our economy, in the Western Cape.
The Western Cape Government’s multi-sectoral TB emergency response plan
This plan is data-driven and iterative, which means that we will develop and strengthen it further as we implement it. It is further guided by the WHO’s Health system building blocks and key levers.
Our primary goal is to make our TB Programme stronger than ever through a back-to-basics approach, the acceleration of innovations, and harnessing collective responsibility through united action to end TB.
In doing so, we have a clear four step programme of action:
- Raise awareness of TB and its harms to our society
- Prevent new TB infections
- Rapidly diagnose TB, commence early initiation of treatment and adherence up to treatment completion
- Mobilise a whole government and whole of society approach to tackle TB
The first step in the response plan is to raise awareness of TB as the leading cause of death in South Africa for more than a decade, encouraging more people to know and see the signs in themselves and others, and to react accordingly. We will do this through:
- Smart interventions including a weekly dashboard, similar to our Covid-19 dashboard. The weekly dashboard will include TB diagnosis from the NICD, TB deaths, treatment successes, treatment initiation, and TB preventative therapy (TPT) initiations.
- This will be supported by a fully-fledged public communications campaign to promote testing and treatment. The campaign will include:
- personal stories, including those of survivors;
- messaging on personal responsibility for prevention; and
- messaging on collective responsibility
- These efforts will be supported by a campaign to destigmatize TB in our communities.
The second step is to prevent new TB infections. We aim to do this by:
- Increasing the uptake of Tuberculosis Preventative Treatment (TPT) at healthcare facilities. This will be done by expanding the Chronic Medical Conditions to include TB treatment and TPT;
- Implementing new TPT regimens including 3HP and 3RH treatments;
- Conducting joint screening of TB and COVID-19 and testing for COVID-19 and TB according to the revised guidelines;
- Implementing a TB Screening App;
- Using the community health worker programme to increase testing for TB among all TB contacts and high-risk populations;
- Improving and maintaining infection prevention and control at healthcare facilities, and other places of congregation;
- Increasing TB testing at shelters used to house homeless people during national emergencies; and
- Maintaining BCG vaccination coverage.
Our third step is ensuring the rapid diagnosis of TB, early initiation of treatment and adherence up to treatment completion. Technology will play a key role in use implementing this step. We will:
- Use SMSs to inform patients of whether they tested negatively or should visit a TB facility;
- We will strengthen hospital management and information systems, and enable linkage to care when patients are referred to other hospitals or the primary health care level if needed;
- Technology will also play a role as we will pilot and progressively expand the use of mobile digital chest x-rays;
- We will implement the urine LAM testing in facilities which is recommended for those with advanced HIV disease or PLHIV with possible TB; and
- This will be supported through targeted universal TB Testing for high-risk groups.
Our fourth step is to mobilise a whole of government and a whole of society response to tackle TB. We will:
- Mobilise all Civil Society organisations to take the lead in our campaign to mobilise citizens and communities in our collective fight against TB
- Establish a multi-sectoral team to define specific contributions for other government departments
Through these steps we aim to not only meet but hopefully exceed global and local commitments to end TB by 2035.
As I have outlined, a person’s socioeconomic circumstances play a huge role in their susceptibility to getting TB. For this reason, another equally important leg of our plan is to conduct enhanced advocacy for socio-economic improvements, including psycho-social and nutritional support interventions for those living with TB.
These efforts will be brought together through the establishment and launch of a Provincial TB Caucus housed in the Western Cape Provincial Parliament.
While our response plan will go a long way, I call on residents, NGOs, faith-based organisations, civil society and those in the private sector to join us in the fight against TB. I speak for myself and for the entire PCAT group when I say that TB is our next big fight, and we are committed to fighting it head on.
If we stand together now, we can defeat TB in the Western Cape and help achieve the well-being and dignity that every single person in our province deserves.